Federal Task Force Suggest Mammograms Start at 40, Not 50

May 9, 2023 – Women should commencement being screened for bosom crab astatine property 40 alternatively of waiting until 50, nan U.S. Preventive Services Task Force said Tuesday successful a draught proposal statement.

The captious alteration successful property for mammograms besides includes nan recommendations for screening each different twelvemonth and sets a cutoff property of 74. 

The task force's ratings strategy shows beardown assurance successful nan grounds for use from nan changes, meaning that doctors should promote their patients to get screened arsenic appropriate. 

The influential national advisory sheet past updated these recommendations successful 2016. At nan time, nan task unit recommended regular screening mammograms starting astatine property 50. 

In nan 2016 recommendations, "we felt a female could commencement screening successful her 40s depending connected really she feels astir nan harms and benefits successful an individualized individual decision," said task unit personnel John Wong, MD, main of objective determination making and a superior attraction expert astatine Tufts Medical Center. "In this draught recommendation, we now urge that each women get screened starting astatine property 40."

Two awesome factors prompted nan change, Wong said. One is that much women are being diagnosed pinch bosom crab successful their 40s. The different is that a increasing assemblage of evidence shows Black women get bosom crab younger, are much apt to dice of bosom cancer, and would use from earlier screening. 

"It is now clear that screening each different twelvemonth starting astatine property 40 has nan imaginable to prevention astir 20% much lives among each women and location is moreover greater imaginable use for Black women, who are overmuch much apt to dice from bosom cancer," Wong said.

The American Cancer Society called nan draught recommendations a "significant affirmative change," while noting that nan task unit recommendations only use to women astatine mean consequence for bosom cancer.

The American College of Radiology already recommends yearly mammograms for average-risk women starting astatine property 40. Its latest guidelines connected mammography, published May 3, ​​call for women astatine higher-than-average consequence for bosom crab to acquisition a consequence appraisal by property 25 to find if screening earlier property 40 is needed.

When asked astir nan differing views, Debra Monticciolo, MD, section main for bosom imaging astatine Massachusetts General Hospital, said yearly screening would prevention much lives than nan every-other-year attack backed by nan task force. Monticciolo besides said that nan disposable technological grounds supports earlier appraisal arsenic good arsenic earlier-than-age-40 screening of galore women, peculiarly Black women. 

"These evidence-based updates should spur more-informed doctor-patient conversations and thief providers prevention much lives," Monticciolo said successful a news release.

Insurance Access

Typically, upgrading a task unit proposal from a people of C to B leads to amended entree and security sum for patients. The Affordable Care Act requires insurers to cover nan costs of services that get A and B recommendations without charging copays — a instruction intended to beforehand greater usage for highly regarded services. 

But Congress created a typical workaround that effectively makes nan Affordable Care Act instruction use to nan 2002 task unit recommendations connected mammography. In those recommendations, nan task unit gave a B people to screening mammograms each 1 aliases 2 years starting astatine property 40 without an property limit. 

Federal lawmakers person sought to supply copay-free entree to mammograms for this full organization moreover erstwhile nan task unit recommendations successful 2009 and 2016 gave a C people to regular screening for women nether 50.

Still, "it is important to statement that our proposal is based solely connected nan subject of what useful to forestall bosom crab and it is not a proposal for aliases against security coverage," nan task unit acknowledged erstwhile unveiling nan caller draught update. "Coverage decisions impact considerations beyond nan grounds astir objective benefit, and successful nan end, these decisions are nan work of payors, regulators, and legislators."

Uncertainties Persist

The caller draught recommendations besides item nan persistent gaps successful knowledge astir nan uses of mammography contempt years of widespread usage of this screening tool. 

The updated draught recommendations stress nan deficiency of grounds to reside awesome areas of interest related to screening and treating Black women, older women, women pinch dense breasts, and those pinch ductal carcinoma successful situ (DCIS), which is besides called shape 0 bosom cancer.

The task unit called for much investigation to reside nan underlying causes of elevated bosom crab decease rates among Black women.

"Nearly half of each women person dense breasts, which increases their consequence for bosom crab and intends that mammograms whitethorn not activity arsenic good for them. We request to cognize much astir whether and really further screening mightiness thief women pinch dense breasts enactment healthy," nan task unit said.

The task unit besides called for much investigation connected approaches to trim nan consequence for overdiagnosis and overtreatment for bosom lesions, specified arsenic DCIS, which are identified done screening.

The task unit will judge comments from nan nationalist connected this draught update done June 5.